GLUCOMETER USE & HYPOGLYCEMIA

What blood glucose level activates the hypoglycemia protocol?

Blood glucose 70 mg/dL or lower.

What is the first action for any patient with hypoglycemia?

Do not delay treatment—treat immediately.

What should be done with scheduled or bedtime insulin during hypoglycemia treatment?

Withhold scheduled or bedtime insulin.

How much fast-acting carbohydrate should an alert patient receive?

20 grams of fast-acting carbohydrate.

Name two examples of fast-acting carbohydrates in the protocol.

6 oz orange juice (no sugar added) or 6 oz non-diet soda

When should blood glucose be rechecked after treatment?

Every 15 minutes until blood glucose is greater than 100 mg/dL.

After blood glucose is above 100 mg/dL, when should it be checked again?

1 hour later.

Who should be notified after treating hypoglycemia?

The physician.

What treatment is given to an unconscious/NPO patient with IV access?

50 mL of Dextrose 50% IV push.

What is the treatment for a child weighing ≥66 lb (30 kg) with IV access?

50 mL bolus Dextrose 50% IV over 1–3 minutes, then 5% dextrose infusion at 100 mL/hr.

What is the treatment for a child weighing <66 lb (30 kg) with IV access?

25 mL bolus Dextrose 50% IV over 1–3 minutes, then 5% dextrose infusion at 100 mL/hr.

What medication is given if an unconscious/NPO patient has no IV access?

1 mg glucagon subcutaneously.

What should be done after giving glucagon?

Recheck glucose every 15 minutes, establish IV access ASAP, and follow IV-access guidelines once available.

What glucagon dose is used for children weighing <25 kg (55 lb)

0.5 mg glucagon subcutaneously.

What glucagon dose is used for children weighing ≥25 kg?

Adult dose (1 mg).

When should glucagon be used?

Only if immediate IV access is not possible.

What condition is a contraindication for glucagon?

Pheochromocytoma.

Why should patients be turned on their side after glucagon administration?

Glucagon often causes nausea and vomiting.

Why may glucagon have a delayed effect?

Because it is absorbed subcutaneously, which is slower.

What is the blood glucose goal before stopping repeat treatment?

Blood glucose greater than 100 mg/dL.

how do you prepare the glucometer test?

Verify order and confirm 2 patient identifiers → perform hand hygiene and put on gloves → explain and gather supplies→ check test strip code matches meter, check strips expiration date→ select fingertip (side of the middle finger)

how do you perform glucometer test?

clean site with alcohol and dry → insert test strip → use lancet on side of finger → wipe first blood drop, use second blood drop → apply pressure until bleeding stops, dispose lancet in sharps → record result

what is hypoglycemia?

blood glucose < 70mg/dL. <54mg/dL is an emergency

Causes

• too much insulin or oral diabetic medication

• skipped or delayed meals

• increased physical activity without meal or medication adjustment

• alcohol intake, especially without food

Signs & Symptoms of hypoglycemia

Mild

• Shakiness/trembling

• Sweating

• Hunger

• Tachycardia

• Anxiety/irritability

Moderate

• Difficulty concentrating

• Confusion

• Blurred vision

• Slurred speech

• Weakness/poor coordination

Severe

• Unable to swallow safely

• Seizures

• Loss of consciousness

• Requires assistance from another person

what patients have increased risk of hypoglycemia?

Insulin or sulfonylurea therapy

• NPO patients still receiving diabetic medication

• Renal or hepatic impairment

• Older adults (may have atypical symptoms)

• New insulin orders or dose changes

• Nausea, vomiting, or poor oral intake